The first time many people think about their own end-of-life wishes is when they create their first Will and Testament with an estate attorney. The Will process usually results in some form of advance directive as part of the documents. This first edition of their advance directive is often about the time people have kids, which means they are younger, and, hopefully, in good health and have many more years to live. Planning for the end-of-life is a far off, Future Problem, as it should be.
The next time many people think about end-of-life wishes is maybe when they update their Will later in life, perhaps once they are Empty Nesters, but still relatively young and healthy. However, for many people, this is the point where they stop updating any version of their advance directive. When it comes time to draw upon these wishes later in life, the wishes are often vague and outdated.
So how often should you update your advance directive? There are 5 crucial times to review, and potentially update, your advance directive. These are known as the “5 D’s” and are Distance, Decade, Diagnosis, Divorce, and Death. Each time your advance directive is updated, the most current version replaces any older versions.
1. Distance
Revisit your advance directive if you move states. States have different forms and some states may not accept an out of state advance directive. If you decide to use the Five Wishes form to document your advance directive, it is accepted as a legal document in 46 states. If you are unsure about the documents, talk to your primary care physician.
2. Decade
Think about revisiting your advance directive at each decade of life. What you want at 40 years old might look very different from what you want at 80 years old. Additionally, your medical power of attorney (POA) may change due to their health or your relationship. The decade mark is a good time to pull out your advance directive and look over it.
3. Divorce (and Marriage!)
In most states, your spouse is the default medical power of attorney (POA) to make your medical decisions for you if you cannot make them for yourself. This is the case even if you are newlyweds and your parents are alive and involved in your life. Your parents have known you your whole life, and if something should happen to you, it is still up to your spouse to make your medical decisions. If your parents and spouse do not agree, this can be a tricky situation.
It is a good idea to have conversations with all those who you would want involved in your medical care so they are informed of your wishes. If you feel strongly that you want someone in addition to your new spouse to be involved, you need to put that in writing in your advance directive.
Conversely, you should revisit your advance directive if you divorce your spouse. You need to think whom you would want to make your medical decisions in their place. This could be your parents, but they may be much older at this point in your life and have their own health problems. If you have children and they are over 18, you might name them after a divorce.
Note, in the natural order of power of attorneys, your children have equal say if you do not have a spouse. Therefore, if you would like one child to be (or not be) your medical decision maker, but you have multiple children, you would need to put that desire in writing. If you have kids and they are under 18, you will need to name someone else as your POA. You can stipulate this to change once your child(ren) is/are over 18.
4. Diagnosis/Disability/Decline
If you have a new medical diagnosis or become disabled, it is important to talk to your medical POA about the kind of care you would want. For example, if you are diagnosed with an aggressive cancer or ALS, you may choose to have a Do Not Resuscitate (DNR) order so that if you pass away naturally, no one attempts to restart your heart. You can also choose to reinforce a desire for aggressive medical care. As always, the kind of care you would want is your choice, but you need to communicate your wishes to your medical POA.
Perhaps you don’t have a single pivotal diagnosis, but your health has generally declined later in life. Maybe you’ve had a number of “health scares” such as a mini stroke, heart issue, or a collection of chronic medical issues. A general decline in your health is also a good time to revisit your advance directive. Your medical wishes may be different if your general quality of life has changed dramatically.
For some people, the decline in their health happens slowly such that it is hard to recognize. Signs that your health is worsening and it may be time to revisit your advance directive include one or more unexpected hospitalizations in the past year (for example, admitted for a hip fracture, pneumonia, or stroke), increased number of falls, and need to move into an assisted living.
5. Death (not yours!)
Similar to divorce, if there is the death of your spouse, or the person you have named as your medical POA, you need to update your advance directive. If you do not name someone, but you have adult children, they will be the default people to make your medical decisions. As stated above, your children have equal say if you do not have a spouse. Therefore, if you would like one child to be (or not be) your medical decision maker, you would need to put that in writing. If you do not have a named POA, things can be complicated and the court may need to appoint someone for you.
How to update
The first version of your advance directive may need to adapt over your lifetime. The 5 D’s – Distance, Decade, Diagnosis, Divorce, and Death are good times to revisit your documents to make sure your wishes have not changed. You can update your advance directive at any time. Updating is easy – just make your changes, get the appropriate signatures and notarization required by your state, and make sure to replace all existing copies. Of course, notify your POA of any changes. If you are unsure, just talk to your primary care physician.